连续性血液净化治疗心血管术后急性肾功能衰竭的时机探讨

目的 探讨连续性血液净化(CBP)治疗心血管术后急性肾功能衰竭(ARF)的疗效.方法 将入选病人按CBP实施前的病情严重程度分为全身炎症反应综合征(SIRS)组13例,多器官功能障碍(MODS)组12例;进行APACHEⅢ评分及常规检测血尿素氮(BUN)和血肌酐(Scr)水平,同时采用放射免疫分析法检测病人血浆中炎症介质白细胞介素(IL)6、肿瘤坏死因子8、(TNF-α)水平.结果 CBP实施24 h后APACHEⅢ评分、血BUN、血Scr,IL-6、8、TNF-α,均较CBP实施前显著降低[(分别为(61±15)vs(81±20),(19±5)mml/L vs(26±5)mmoVL,(312±87)/μmol/L vs(458±107)μmol/L,(544±154)ng/L vs(842±132)ng/L,(18±7)ng/L vs(25±8)ng/L,(43±15)ng/L vs(59±17)ng/L].SIRS、MODS组病人的存活率分别为84.62%、41.67%(P<0.05);CBP实施前和实施24 h后MODS组ARF病人的APACHEⅢ评分、血BUN、血Scr,血清IL6、IL-8均显著高于SIRS组.结论 APACHEⅢ评分为60～90分时可能是心血管术后发生ARF实施CBP治疗的较理想时机.     

连续性血液净化治疗重症肺炎合并呼吸衰竭的临床疗效观察

目的探讨连续性血液净化（CBP）治疗重症肺炎合并呼吸衰竭的临床疗效及对炎性因子的影响。方法将86例重症肺炎合并呼吸衰竭患者按随机数字表法分为对照组和研究组,每组43例。两组患者均采用吸氧、抗感染、辅助通气、解痉等常规治疗,研究组在此基础上予以CBP治疗。两组患者治疗前及治疗3、7d后分别测定外周血相关炎性因子水平和动脉血气指标、APACHEⅡ评分,判定临床疗效。结果治疗3、7d后,研究组患者TNF-α、IL-6、IL-8、C反应蛋白（CRP）水平较治疗前均明显降低,且均显著低于对照组,差异均有统计学意义（P＜0.05或0.01）。治疗3、7d后,研究组PaO2、氧合指数（PaO2/FiO2）较对照组显著升高,PaCO2较对照组显著降低,差异均有统计学意义（P＜0.05或0.01）。治疗7d后,研究组APACHEⅡ评分明显低于对照组,差异均有统计学意义（均P＜0.05）。结论重症肺炎患者在常规治疗基础上联合使用CBP治疗可明显降低患者体内的炎性因子水平,明显改善肺部氧合功能,降低APACHEII评分,改善患者预后。     

血必净注射液对急性肺损伤患者血清IL-6、TNF-α的影响

目的:探讨血必净注射液对急性肺损伤(ALI)患者血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)影响.方法:采用ELISA法测定ALI 32例加用血必净注射液治疗(治疗组)与31例不加用者(对照组)治疗前、治疗后第8d血清中IL-6、TNF-α含量.两组均于治疗前及治疗后第8d进行急性生理学及慢性健康状况(APACHEⅡ)评分.结果:IL-6、TNF-α、APACHEⅡ三者治疗前两组比较均无明显差异(P＞0.05);两组治疗后第8d三者均较治疗前明显降低(P＜0.05,P＜0.01),且治疗组较对照组降低更显著(P＜0.05,P＜0.01).结论:血必净注射液可使ALI者血清中IL-6、TNF-α含量水平降低,而且APACHEⅡ评分也相对降低.     

连续性血液净化治疗心脏术后急性肾功能衰竭的效果评价

目的:观察连续性血液净化(CBP)在心脏术后急性肾功能衰竭(ARF)患者防治中的疗效,并探讨CBP治疗的时机。方法:将18例心脏术后ARF患者分为A组(n=8,符合SIRS诊断)及B组(n=10,符合MODS诊断),对全部患者治疗前和治疗24h后进行ATN-ISI评分、APACHE评分,同时记录氧合指数,平均动脉压(MAP),心率(HR),中心静脉压(CVP),pH值,血尿素氮(BUN)和血肌酐(Scr)等指标进行比较。结果:1B组的病死率明显高于A组(70.0%vs12.5%);2CBP治疗24h后,A组及B组的APACHE评分、氧合指数、BUN和Scr显著改善,仅A组的MAP,pH值显著改善;而两组病人ATN-ISI评分、CVP、HR在治疗前后无明显差异。结论:CBP能改善心脏术后重症ARF的病情,但必须强调尽早认识SIRS并行CBP治疗,从而减少并发症的发生,降低病死率。     

早期血液净化治疗对全身炎症反应综合征及脓毒症患者治疗作用的研究

目的应用连续性血液净化技术（CBP）对全身炎症反应综合征（SIRS）及脓毒症（sepsis）患者进行治疗,探讨其对SIRS患者细胞因子及预后的影响。方法37例SIRS患者及25例sepsis患者行连续性血液净化治疗24h,于CBP治疗前0h,CBP治疗后6、12、24、36h,测血清细胞因子肿瘤坏死因子-α（TNF-α）、白介素-1（IL-1）、IL-6,同时观察治疗组CBP前后的APACHEⅡ、血乳酸、胃黏膜动脉血二氧化碳分压差（Pg-aCO2）的变化,并与对照组比较28d存活率。结果接受CBP的SIRS患者TNF-α在6、24及36h后,IL-1在36h后以及IL-6在12和36h后明显低于0h（P〈0．05）;接受CBP的sepsis患者TNF-α及IL-6 36h后明显低于0h（P〈0．05）,IL-1在12、36h后明显低于0h（P〈0．05）：在36h,治疗组TNF-α、IL-1、IL-6水平较对照组明显低（P〈0．05）,SIRS患者在36h的TNF-α水平明显低于sepsis患者（P〈0．05）;治疗组患者APACHEⅡ评分、血乳酸、Pg-aCO2下降（P〈0．05）;治疗组患者28d存活率明显高于对照组（62．90％vs26．67．％,P〈0．05）。结论CBP有良好的清除细胞因子效果,改善SIRS、sepsis患者的预后：在血液净化选择时机上应尽可能早。     

连续性血液净化治疗心脏术后急性肾衰

目的探讨连续性血液净化(CBP)治疗心脏术后急性肾功能衰竭(ARF)的疗效.方法8例心脏术后并发ARF患者行CBP治疗.结果3例(37.5%)存活,5例死亡.透析30min后患者心率显著减慢(P＜0.05);1h后动脉氧分压显著升高(P＜0.05);4h后平均动脉压显著上升(P＜0.05).透析8h后血清Cr、BUN、K+显著降低(P＜0.05).结论CBP是治疗心脏术后并发ARF的有效手段.     

连续性血液净化与间歇性血液透析治疗重症急性肾衰竭的疗效比较

目的:对比连续性血液净化(CBP)与间歇性血液透析(IHD)治疗重症急性肾衰竭(ARF)的临床疗效.方法:选择我院ICU于2014年1月~2016年12月间收治的32例重症ARF患者为研究对象,将17例接受CBP治疗者纳入观察组,15例接受IHD治疗者纳入对照组,比较两组患者治疗前后血流动力学指标及Scr、CRP及APACHEⅡ评分的变化,比较两组患者28d死亡率.结果:观察组患者上机后MAP及HR较治疗前无明显变化,对照组上机后MAP明显降低,HR明显升高,且与观察组比较差异有统计学意义;两组患者治疗后Scr、CRP及APACHEⅡ评分均较治疗前明显降低,观察组明显低于对照组,差异有统计学意义;两组患者28d死亡率比较差异无统计学意义.结论:CBP治疗重症急性肾衰竭,与IHD比较可以保持血流动力学稳定,有效促进患者肾功能的恢复、降低炎症反应并减轻疾病的严重程度.     

连续性血液净化在劳力性热射病合并横纹肌溶解综合征患者中的应用

目的 探讨连续性血液净化(CBP)对劳力性热射病(ExHS)合并横纹肌溶解综合征(RM)患者的临床价值.方法 16例ExHS合并RM患者,急性生理及慢性健康评分标准Ⅱ (APACHE Ⅱ评分)＞20分,经股静脉留置单针双腔管,行连续性静脉-静脉血液滤过(CVVH)治疗.于CBP前及CBP后第3天分别测定门冬氨酸氨基转移酶(ALT)、丙氨酸氨基转移酶(AST)、尿素氮(BUN)、肌酐(Scr)、肌酸激酶(CK)及肌红蛋白值,并监测治疗前后进行APACHE Ⅱ评分.结果 CBP治疗后,患者CK及肌红蛋白下降明显(均P＜0.01),肝肾功能明显改善(均P＜ 0.01),APACHE Ⅱ评分亦下降明显(P＜0.01).结论 CBP应用于ExHS合并RM患者,具有促进CK及肌红蛋白的排出,保护肝肾功能,改善预后,具有良好的临床疗效.     

连续性血液滤过治疗老年性急性心肌梗死后合并多器官功能障碍综合征

目的 探讨持续血液滤过(CH)对老年性急性心肌梗死(AMI)后合并多器官功能障碍综合征(MODS)患者预后的影响.方法 分析送入监护室治疗的AMI后合并MODS的老年患者34例,根据是否行CHF治疗分为CH组及非CHF组(NCH),观察并比较治疗前、治疗7d时两组患者APACHE Ⅱ评分及Marshall评分变化,并比较两组患者28 d死亡率及90d死亡率.结果 两组患者治疗前APACHE Ⅱ评分及Marshall评分无显著差异,而治疗7 d后CH组APACHE Ⅱ评分及Marshall评分均较治疗前显著降低(分别P<0.05、P<0.01),而NCH组APACHE Ⅱ评分较治疗前显著增高(P＜0.01),Marshall评分则变化不大(p＞0.05).28 d总病死率、90 d总病死率分别为41.18%、61.76%,而CH组、NCH组28 d病死率有显著差异(p<0.05);而两组90 d病死率无显著差异(p>0.05).结论 CH可改善老年性AMI后合并MODS患者器官功能状态及短期预后,但对其长期预后无改善作用.     

连续性血液净化对多脏器功能障碍综合征患者炎症介质的影响

目的探讨连续性血液净化（CBP）在多器官功能障碍综合征（MODS）中的应用及对血浆TNFα-、IL-1β和高迁移率族蛋白1（HMGB-1）浓度的影响。方法 MODS患者39例,在基础治疗上给予CBP治疗,于CBP前、CBP开始后4 h、12 h、24 h、48 h、72 h留取血标本,用ELISA法测定血浆TNF-,αIL-1β和HMGB-1;治疗前、治疗后24 h、48 h、72 h行急性生理功能和慢性健康状况（APACHEⅡ）评分,同时以未行CBP治疗的MODS患者25例作为对照。结果与CBP前比较,TNFα-、IL-1,βHMGB-1明显下降（P〈0.05）;CBP治疗48 h、72 h后APACHEⅡ评分明显下降（P〈0.05）。与对照组相比,在各时间点TNFα-、IL-1β、HMGB-1均下降,差异有统计学意义（P〈0.05）;APACHEⅡ评分明显降低（P〈0.05）。两组患者28 d病死率差异无统计学意义（P〉0.05）。结论过度的炎症反应是MODS发生的本质原因之一,CBP能够削弱血循环中炎症介质的峰值浓度,有效遏制过度的炎症反应,从而起到防治MODS的作用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.